Provider Demographics
NPI:1083613517
Name:HARTWELL, ALEX (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:HARTWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:J
Other - Last Name:WALKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5225 N IRONWOOD RD
Mailing Address - Street 2:STE 118
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4909
Mailing Address - Country:US
Mailing Address - Phone:414-308-1091
Mailing Address - Fax:414-308-1092
Practice Address - Street 1:5225 N IRONWOOD RD
Practice Address - Street 2:STE 118
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4909
Practice Address - Country:US
Practice Address - Phone:414-308-1091
Practice Address - Fax:414-308-1092
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI420-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39590000Medicaid
WI39590000Medicaid